Clinical manifestations of hyperprolactinemia

Hyperprolactinemia is a very common disease, which seriously affects the physical and mental health of patients and makes them very distressed. So, what are the clinical symptoms of hyperprolactinemia? Next, we will introduce the various clinical symptoms of hyperprolactinemia.

1. Clinical manifestations of hyperprolactinemia: (1) Hypogonadism: Patients with prepubertal onset may present with primary hypogonadism, i.e., primary amenorrhea in girls, no puberty in boys, and small testicular volume. Women of childbearing age often have changes in their menstrual cycle, with varying degrees of infrequent menstruation or even amenorrhea, which usually affects ovulation and causes infertility.

Low serum estrogen levels can cause breast atrophy, pubic hair loss, vulvar atrophy, decreased vaginal discharge, osteoporosis, etc. Decreased androgen levels in male patients can lead to decreased libido, impotence, decreased ejaculation volume and sperm count, infertility, and osteoporosis. Because male patients have latent symptoms and low specificity, they are often ignored, resulting in late medical treatment.

(2) Lactation: 30%-80% of female patients with hyperprolactinemia experience spontaneous or triggered lactation. After sexual dysfunction occurs, the incidence of lactation also decreases due to low estrogen levels. Male patients may have mild breast development, and a few patients may also experience lactation. (3) Weight gain: The specific cause is unclear, but it may be related to sodium and water retention, abnormal fat differentiation, sexual dysfunction, and hypothalamic dysfunction.

2. Local compression symptoms of the tumor: It is common in pituitary prolactinoma. The most common local compression symptoms are headache and visual field loss (the most common is bitemporal hemianopsia). If the tumor grows to both sides, it can surround the cavernous sinus, affecting the function of the third, fourth, sixth cranial nerves and the ophthalmic branch of the fifth cranial nerve, causing ptosis, loss of pupillary light reflex, diplopia, eye movement disorders, facial pain, etc.

If the tumor destroys the sphenoid or ethmoid sinus bones, cerebrospinal fluid leakage may occur. Macroadenomas compressing normal pituitary tissue may also cause other manifestations of impaired anterior pituitary function, such as hypothyroidism or adrenocortical insufficiency.

3. Symptoms of multi-hormone mixed adenoma or multiple endocrine adenoma: Prolactin-secreting mixed adenoma that secretes growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, etc. may be accompanied by excessive secretion of other anterior pituitary hormones, such as acromegaly, hyperthyroidism, Cushing's syndrome, etc.

In addition, pituitary tumors can also be one of the manifestations of multiple endocrine neoplasia (MEN), especially MEN-I type, so attention should be paid to the presence of other endocrine gland dysfunctions such as pancreatic neuroendocrine tumors and hyperparathyroidism.

4. Pituitary stroke: Pituitary apoplexy may occur in prolactin-secreting pituitary adenomas, usually in large adenomas. Acute pituitary stroke may present as severe headache, often accompanied by nausea.